The Sequoia circular fixator for limb lengthening.

With the Sequoia fixator, lengthenings can be achieved based on the clinical facts of the case. The device is a modular apparatus that can perform corrections in several planes, and, if necessary, in a septic environment. In our opinion, a "lengthener surgeon" is one who can foresee problems and take appropriate steps to prevent them. Likewise, the surgeon must act as the coordinator of an entire team. A successful lengthening is 5% surgery and 95% postoperative nursing and physiotherapy care. In the future, a number of changes will simplify postoperative management: 1. Composite carbon rings will make the frames radiolucent and one third lighter than those made of stainless steel. Automatic tensioners will help maintain steady tension on the wires. 2. Digital analysis of the callus will provide norms of consolidation, allowing faster fixator removal and conversion to an orthosis. 3. Incorporating the foot in the frame to overcome equinus will eliminate the need for tenotomy. We believe that monolateral and ring fixators can work together in certain locations. That is why we proposed, at the 18th Societé Internationale de Chirurgie Orthopédique et Traumatologique meeting, a combined monolateral-ring construct that can be used for lengthening throughout the proximal femoral metaphysis.

Articular cartilage atrophy in lower limb amputees.

A retrospective and radiologic survey of the hips of 53 above-knee amputees showed that none of these hips was normal. Osteoporosis was present in all subjects, and cartilage thickness was reduced in 27 cases. This reduced thickness was inversely correlated with stump length, since it occurred in 11 of 13 upper-third amputees, but in none of 10 lower-third amputees. The mechanisms of cartilage atrophy are discussed.